Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist. It reduces albuminuria in short-term trials involving patients with chronic kidney disease and type 2 diabetes. Finerenone had more potent antiinflammatory and antifibrotic effects than steroidal mineralocorticoid receptor antagonists in preclinical modes. It has been shown to reduce the urinary albumin-to-creatinine ratio in patients with CD treated with a RAS blocker while having fewer serum potassium levels than spironolactone.

In a double-blind trial, patients with CKD and type 2 diabetes were randomly assigned in a 1:1 proportion to receive finerenone or placebo. The study results showed that for the period of a median follow-up of 2.6 years, a primary outcome event transpired in 504 of 2833 patients (17.8%) in the finerenone group while 600 of 2841 patients (21.1%)in the placebo group (hazard ratio, 0.82; 95% CI, 0.73 to 0.93; P=0.001). The results demonstrated that treating the CKD and type2 diabetes patients with finerenone led to lower CKD progression risks and cardiovascular events than placebo.

Reference

Bakris LG, Agarwal R, Anker SD, Pitt B, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020; 383: 2219-2229.